ABSTRACT
Objective:To investigate the therapeutic effect of dl-3-n-butylphthalide on dysphagia after cerebral infarction.Methods:Seventy acute cerebral infarction patients with dysphagia who received treatment in The First People's Hospital of Huzhou from December 2019 to December 2020 were included in this study. They were randomly assigned to receive either routine treatment combined with swallowing function training (routine treatment group, n = 35) or intravenous dl-3-n-butylphthalide, routine treatment, and swallowing function training in combination (dl-3-n-butylphthalide treatment group, n = 35). All patients received 2 weeks of treatment. Clinical efficacy and swallowing function training pre- and post-treatment were compared between the two groups. Results:Total response rate was significantly higher in the dl-3-n-butylphthalide treatment group than in the routine treatment group [100.0% (35/35) vs. 91.4% (32/35), χ2 = 1.39, P = 0.238]. Before treatment, there were no significant differences in the scores of the Water-Swallowing Test and the Standardized Swallowing Assessment between the two groups ( P = 0.898, 0.691). The scores of the Water-Swallowing Test and the Standardized Swallowing Assessment measured after treatment in the dl-3-n-butylphthalide treatment group were (0.68 ± 0.76) points and (21.60 ± 2.50) points, which were significantly lower than those in the routine treatment group [(1.15 ± 0.77) points, (27.62 ± 3.80) points, t = 2.57, 7.82, P = 0.012, < 0.001]. Conclusion:Dl-3-n-butylphthalide treatment is highly effective on dysphagia after acute cerebral infarction. It can effectively promote the recovery of a patient's swallowing function. The treatment method is worthy of clinical application.
ABSTRACT
We report the diagnosis and treatment of a rare case of epidural analgesia failure followed by postpartum subdural hematoma. The patient underwent vaginal delivery under epidural analgesia at 32 +6 gestational weeks due to threatened premature labor, during which an unexpected dural rupture occurred. She gave no history of headache and there was no obvious abnormality during the pregnancy. However, on postpartum day 4, the patient complained of headache that could not be relieved when supine, but without any other neurological symptoms. A prompt cranial CT examination showed a left frontotemporal subdural hematoma. After conservative management with intravenous drip of mannitol, re-examination of cranial CT showed that the left frontotemporal subdural hematoma was mostly absorbed and the patient was discharged on postpartum day 18. The patient was healthy during follow up. Intracranial subdural hematoma after dural puncture is a rare and serious complication that requires early recognition and treatment.
ABSTRACT
OBJECTIVE To analyze the si tuation and hot spots of gabapentinoid drugs in the treatment of pain. METHODS Related researches about gabapentinoid drugs in the treatment of pain were retrieved from Web of Science core collection database during Jan. 1st，2011-Dec. 31st，2020. VOSviewer 1.6.17，CiteSpace 5.8.R1 and Excel 2018 software were used to statistically analyze the key characteristics of relevant literature ，such as the annual publications ，countries/regions，institutions，authors， journals and research hot spots. RESULTS & CONCLUSIONS A total of 3 519 literatures were retrieved ，and the annual publication outputs showed an upward trend generally. Totally 86 countries/regions had conducted relevant studies ，of which the United States ranked first （up to 1 219），and had close cooperation with the United Kingdom ，Canada，China，Germany，Japan， etc；a total of 3 996 institutions had published relevant literatures ，and the Pfizer Inc. issued the most publications ；the most studies were devoted by Professor Parsons from the University of California San Diego ，and the highest co-citations author was Professor Gilron from the Queen ’s University. Among 1 185 journals，Pain ranked first not only in the high-productive journal ，but also in the co-cited journal. The main hot topics include abuse and misuse of gabapentinoid ，off-label use of gabapentinoid ，clinical application of gabapentinoid as a component of multimodal analgesia ，and the update of guidelines for pain based on systematic evaluation and meta-analysis.
ABSTRACT
Objective:To study our initial experience on feasibility and safety of magnetic compression anastomosis in laparoscopic pancreaticoduodenectomy(LPD).Methods:A retrospective analysis was conducted on the data of 7 patients who underwent LPD with laparoscopic magnetic compression choledochojejunostomy (LMC-CJ) or pancreaticojejunostomy (LMC-PJ) at the Department of Hepatobiliary Surgery, the First Affiliated Hospital of Xi’an Jiaotong University from May 2018 to September 2019. There were 6 males and 1 female. The median age of patients was 63 (56-83) years. Data analyzed included the model of the magnetic anastomosis device, operation time of the LMC-CJ or LMC-PJ, other operation-related parameters, postoperative complications, time to perform magnetic anastomosis, and time of discharge of the magnet from patients’ body.Results:All 7 patients completed LPD successfully, including 7 LMC-CJ and 2 LMC-PJ. The median operation time was 340 (310-450) minutes. The median diameter of the biliary-enteric magnetic anastomosis ring used was 10 (9-12) mm, and the median time of the biliary-enteric magnetic anastomosis was 11 (8-16) min. The diameter of the pancreaticojejunal magnetic anastomosis ring was 5 mm in the two anastomoses, and the times taken were 12 min and 15 min. Complications occurred in 4 patients, including 1 patient each for grade A and grade B pancreatic fistula, 2 patients with abdominal infection, 2 patients with postoperative gastric emptying disorder, and 1 patient with abdominal hemorrhage. All patients responded to conservative treatment. There was no biliary or pancreatic fistula at the magnetic anastomoses. Pancreaticojejunostomy functioned at 24 and 30 days after operation. The median time for the magnets to pass out from the body of all patients was 50 (40-170) days. The median follow-up was 11 (4-18) months. No biliary-enteric or pancreaticojejunostomy stenosis was detected.Conclusion:Magnetic compressive anastomosis was simple, feasible, and safe for choledochojejunostomy or pancreaticojejunostomy in LPD.
ABSTRACT
We report the induced labor of conjoined twins in the second trimester in a woman with a history of two previous cesarean sections, the last one of which was performed in 2017. This 25-year-old patient was found to have thoracolumbar conjoined fetuses with one heart and polyhydramnios through the routine ultrasound examination at 19 +5 gestational weeks and was admitted at 20 +1 gestational weeks. After a full assessment of the fetal and maternal condition through multidisciplinary consultation, it was determined to attempt a vaginal delivery as no absolute contraindication for induction of labor. The patient was given 300 mg mifepristone orally plus an amniotic cavity injection of 100 mg ethacridine lactate. Regular contractions occurred 28 hours after medication. The patient delivered a pair of dead female conjoined twins at 20 +6 gestational weeks following successful induction of labor, with an assisted vaginal breech delivery. There was no soft tissue damage in the birth canal, and the estimated blood loss was 150 ml. Pathological examination and autopsy showed thoracolumbar conjoined deformity twins with a common heart and liver. Adequate prenatal evaluation, a detailed understanding of the indications for induction of labor and vaginal delivery, closed monitoring during labor, and preparation for emergency cesarean section, are essential safety measures for induced labor of conjoined twins in women with a scarred uterus in the second trimester.
ABSTRACT
Objective:To investigate the diagnosis and treatment of hepatic artery thrombosis (HAT) after adult orthotopic liver transplantation.Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 411 patients who underwent adult orthotopic liver transplantation in the First Affiliated Hospital of Xi ′an Jiaotong University from December 2011 to July 2018 were collected. There were 328 males and 83 females, aged from 21 to 66 years, with a median age of 46 years. Observation indicators: (1) incidence of HAT and its clinical characteristics; (2) diagnosis of HAT; (3) treatment of HAT; (4) follow-up. Follow-up using outpatient service, telephone interview or WeChat group communication was conducted to detect the incidence of biliary stricture and survival of patients up to August 2018. Measurement data with normal distribution were represented as Mean± SD, measurement data with skewed distribution were represented as M(range). Count data were described as absolute numbers or percentages. Survival rate was estimated using the Kaplan-Meier method. Results:(1) Incidence of HAT and its clinical characteristics: 11 of 411 patients had HAT after orthotopic liver transplantation with the incidence of 2.68%(11/411), including 10 males and 1 female, aged 44 years(range, 22-63 years). The time to occurrence of postoperative HAT was 4 days(range, 1-15 days). The etiologies of 11 patients included 6 cases of hepatitis B virus-related cirrhosis, 1 case of hapatitis related cirrhosis, 1 case of hepato-cellular carcinoma, 1 case of liver cirrhosis, 1 case of alcoholic hepatitis related cirrhosis, 1 case of wilson disease. All the 11 patients were ABO compatible. The cold ischemic time and warm ischemic time of donor liver were (316±89)minutes and (13±4)minutes, respectively. Type Ⅰ arterial anasto-mosis was conducted in 11 patients. The clinical manifestations included asymptomatic type in 10 patients and sepsis type in 1 patient. (2) Diagnosis of HAT: all the 11 patients were confirmed with HAT by endovascular angiography, including 7 cases showed no arterial flow under Color Doppler ultrasound, and contrast-enhanced ultrasound indicated HAT. Two patients showed increased hepatic artery resistance index under Color Doppler ultrasound, and contrast-enhanced ultrasound indicated 1 case of HAT and 1 case of anastomotic stenosis. One patient showed slow velocity of hepatic artery blood flow and low resistance index under color Doppler ultrasound, and contrast-enhanced ultrasound indicated HAT. One patient showed slight blood flow signals under Color Doppler ultrasound, and contrast-enhanced ultrasound indicated HAT. (3) Treatment of HAT: 11 patients received endovascular therapy. Six patients had HAT completely disappeared after thrombolytic therapy, 5 patients with residual thrombosis continued thrombolytic therapy with microcatheter urokinase. Six patients with complications were improved after symptomatic treatment. HAT completely disappeared after (6.7±2.6)days of treatment and the clinical success rate was 11/11. (4) Follow-up: 11 patients were followed up for 19-1 722 days, with a median follow-up time of 46 days. During the follow-up, 4 patients had biliary stricture and underwent stent implantation. Nine patients survived with 1-, 3-, 5-year overall survival rates of 75%, 75%, 75%, and 2 patients died.Conclusions:The incidence of HAT after adult orthotopic liver transplantation is low and clinical manifestations are atypical. Contrast enhanced ultrasound can improve diagnosis of suspected thrombosis. Endovascular therapy is safe and effective, which can significantly improve the blood flow of hepatic artery.
ABSTRACT
OBJECTIVE：To systematically evaluate the effects of CYP1A2 gene polymorphisms on blood concentrations of antipsychotic drugs （haloperidol，clozapine，olanzapine），and to provide evidence-based reference for the clinical drug use . METHODS：Retrieved from Cochrane Library ，PubMed，Embase，CBM，CNKI and Wanfang data ，during the inception to Nov. 2019，cross-sectional study was conducted to investigate the effects of CYP1A2 gene polymorphisms on blood concentrations of antipsychotic drugs （haloperidol，clozapine，olanzapine）were collected. After screening the literature ，extracting the data and quality evaluation with Q-Genie tool ，Meta-analysis was performed by using Rev Man 5.3 software. RESULTS ：A total of 11 cross-sectional studies were included ，with a total of 914 patients. Of these ，haloperidol was used in 2 studies，clozapine was used in 5 studies，and olanzapine was used in 4 studies. Meta-analysis showed that there was no statistically significant difference in the blood concentration of haloperidol between CYP1A2（－2964G＞A）G/G type and G/A+A/A type [SMD ＝－0.22，95％CI（－0.66， 0.23），P＝0.35]. The blood concentration of clozapine in CYP1A2（－163C＞A）A/C type was significantly lower than C/C type [SMD ＝0.31，95％CI（0.01，0.62），P＝0.04]；there was no statistical significance in blood concentration of clozapine between A/A type and C/C type [SMD ＝0.09，95％CI（－0.21，0.40），P＝0.56]，between A/A type and A/C type [SMD ＝－0.22，95％CI（－0.55， 0.10），P＝0.18]，between CYP1A2（－2467delT）delT/delT type and T/T type [SMD ＝－0.11，95％CI（－0.75，0.52），P＝0.72]， between delT/T type and T/T type [SMD ＝0.01，95％CI（－0.33，0.34），P＝0.97]，between delT/delT type and delT/T type [SMD ＝ －0.15，95％CI（－0.80，0.05），P＝0.66]. The blood concentration of olanzapine in CYP1A2（－163C＞A）A/A type was signifi- cantly lower than A/C type [SMD ＝－0.31，95％CI（－0.55， － 0.08），P＝0.009]；there was no statistically significant difference in the blood concentration of olanzapine between A/A liukefeng-num.1@163.com type and C/C type [SMD ＝－0.20，95％CI（－0.61，0.21），P＝ 0.34]，between A/C type and C/C type [SMD ＝0.06，95％CI E-mail：hnmuzj@163.com （－0.35，0.47），P＝0.77]，between CYP1A2（－2467delT）delT/T type and T/T type [SMD ＝0.28，95％CI（－0.15，0.71），P＝0.20]. CONCLUSIONS：CYP1A2（－163C＞A）A/C type is related to the reduction of clozapine blood concentration ，and A/A type is related to the reduction of olanzapine blood concentration. CYP1A2 （－163C＞A）gene polymorphism is significance for guiding individualized medication of schizophrenia patients.
ABSTRACT
Objective Toexplorethesedativeeffectsandsafetyofdexmedetomidinewithketaminemixturenasaldropsbesideschloralhydrateoral andenemainchildren MRIexamination.Methods 619children (Group A)weresedatedbydexmedetomidinewithketamine,289 children(GroupB)weresedatedbychloralhydrateenemaand417childrenweresedatedbyoralchloralhydrate(GroupC)respectivelyinour hospital.ThelatestRamsaysedationscorewasadoptedtodeterminethesedationdepth.Thesedationscores,inductiontime,examinationtimeand recoverytimewererecordedrespectivelybeforeinduction,afterinductionandafterawakening.Results (1)Theinductiontimeof dexmedetomidinewithketaminewassignificantlyshorterthanchloralhydrate,anditsdifferencewasofstatisticmeaning(P<0.05). (2)ThesuccessrateofexaminationinGroupAwas100%;groupB61.6%;GroupC65.2%.ThesuccessrateofgroupAwassignificantlyhigher thanthatinbothgroupBandgroupC,thusthedifferencewasalsostatisticallysignificant.Conclusion AllmethodsaresafeforpediatricMRIat appropriatesedationdepth.Thesedativefailurerateofchloralhydrateishigher.Theinductionandawakeningtimeofdexmedetomidinewith ketaminemixturedropsisrelativelyshorter,thereforeithasgoodsedativeeffectintheMRIexamination.
ABSTRACT
BACKGROUND: In recent years, the development of tissue engineering has provided a new approach for the treatment of periodontal bone defect. Tissue engineering therapy includes seed cells, scaffolds and growth factors. Platelet gel contains a large number of platelet growth factors, and collagen is often used for the preparation of scaffold materials. Therefore, the platelet gel and collagen biologically active composite membrane can provide scaffolds and growth factors for the defect bone. OBJECTIVE: To investigate the effect of autologous platelet gel-collagen biologically active composite membrane on the repair of periodontal bone defect in rats. METHODS: Forty-two Wistar rats (Shanghai Xipuer-Bikai Experimental Animal Co., Ltd., China) were selected. (1) Collagen was cut into 5 mm×2 mm size, and 10 mL of whole blood was extracted from 6 rats to obtain platelet-rich plasma. Autologous platelet gel-collagen composite membrane was prepared by adding bovine thrombin, calcium chloride and collagen in a certain proportion. Platelets in whole blood and in platelet-rich plasma were detected. The levels of platelet derived growth factor AB, transforming growth factor-β, basic fibroblast growth factor and vascular endothelial growth factor in whole blood and platelet-rich plasma were detected by ELISA. (2) The models of mandibular periosteal defect were established in 36 rats (the size of the bone defect was 5 mm×2 mm, and the root surface cementum was removed) , and randomly divided into two groups. Autologous platelet gel-collagen group placed the autologous platelet gel-collagen composite membrane in the bone defect, and the control group did not place any materials. The hematoxylin-eosin staining of periodontal tissues of rats in each group was analyzed at 2, 4 and 8 weeks after surgery. Rate of new born, new centumum formation, new alveolar bone formation, and new periodontal ligament tissue formation height were measured. The expression of bone morphogenetic protein-2 was detected by immunohistochemical staining. RESULTS AND CONCLUSION: (1) The mean platelet count in platelet-rich plasma was 4.78 times as high as the whole blood, indicating that the number of platelets increased significantly after prepared into platelet-rich plasma (P < 0.05) . The levels of platelet derived growth factor AB, transforming growth factor-β, basic fibroblast growth factor and vascular endothelial growth factor in platelet-rich plasma were 3.10, 3.45, 7.17 and 5.45 times of the whole blood, respectively (P < 0.05) . (2) The results of hematoxylin-eosin staining observed that the rate of new born, new centumum formation, new alveolar bone formation, and new periodontal ligament tissue formation height at 2 weeks in the autologous platelet gel-collagen group showed no significant difference from the control group (P> 0.05) . At 4 and 8 weeks, all above indexes in the autologous platelet gel-collagen group were significantly higher than those in the control group (P < 0.05) . (3) Results of immunohistochemical staining revealed that at 2 weeks, bone morphogenetic protein-2 in the autologous platelet gel-collagen group began to express, and the expression of bone morphogenetic protein-2 was highest at 4 weeks (P < 0.05) , and the positive expression was weakened at 8 weeks (P> 0.05) . (4) Our results clarify that autologous platelet gel-collagen bioactive composite membrane can significantly promote the regeneration of new tooth, which is associated with the expression of bone morphogenetic protein-2, and reduce the repair time after periodontal tissue defect.
ABSTRACT
Objective:To explore the effect of grief counseling for relieving donor family′s grief. Methods:From September 2012 to February 2015, 180 families of potential organ donors, who met the class III standard of China, were invited to participate in this study. The grief score was evaluated using questionnaire before and after grief counseling. Results:All of 180 potential organ donor′s families had different level of sadness. The grief was significantly reduced after grief counseling and the score was significantly lower than before ( P<0 . 05 ) . Sixty-five cases agreed to donate organ and 60 cases succeed. Conclusion:Grief counseling for potential organ donor′s families could relieve their grief effectively. This method is beneficial for communication of organ donation and pro-moting donation career of China.
ABSTRACT
Objective To evaluate the clinical efficacy of early enteral nutrition combined with additional parenteral nutrition (EEN + PN) versus TPN (total parenteral nutrition) in patients after conventional pancreaticoduodenectomy (PD).Methods From January 2009 to January 2013, 340 consecutive patients who underwent conventional PD with Child's reconstruction at the First Affiliated Hospital of Xi'an Jiaotong University were enrolled into this single-center retrospective comparative study.There were 87 patients in the EEN + PN group and 253 patients in the TPN group.The preoperative baseline characteristics,histopathological types, intraoperative parameters and postoperative outcomes were recorded and compared between the two groups.Results There were no significant differences in the preoperative general characteristics data, pathological patterns, and intraoperative details.There were significantly higher rates in delayed gastric emptying (DGE), morbidity (15.9％ vs 6.7％, P ＜ 0.05), and pneumonia (10.3％ vs 3.6％, P ＜ 0.05);significantly prolonged nasogastric tube removal time (5.6 ± 0.2 days vs 3.9 ± 0.1 days, P＜0.05), and increase in hospitalization expenses (65 397.0 ± 861.2) Yuan vs (50 663.9 ± 239.2) Yuan, P ＜ 0.05) in the EEN + PN group when compared with the TPN group.Conclusions EEN + PN after conventional PD was associated with increased rates of DGE and pneumonia, prolonged nasogastric tube removal time, longer EN duration and increase in hospitalization expenses.Hence, EEN should only be performed prudently and selectively.
ABSTRACT
Objective To analyze the clinicopathological characteristics and the prognostic survival factors of young patients who have undergone hepatectomy for primary hepatic carcinoma.Methods Clinicopathological da-ta and treatment outcomes in 79 young (≤40 years old)and 67 elderly (≥65 years old)patients who underwent hep-atectomy for primary hepatic carcinoma between 2008 and 2012 were retrospectively collected and compared using various parameters.Then the survival rate and prognostic factors of the younger patients were analyzed using Kap-lan-Meier and COX multivariate proportional hazards model.Results The positive rate of HBs-antigen and alpha-fetoprotein level were significantly higher in the younger patients than in the elderly patients (P0.05).The overall survival rate was similar between the two groups.COX multivariate proportional hazards model analysis showed that the independent prognostic factors of overall survival were pre-operative albumin level <3 5 g/L and maximum tumor diameter ≥5 cm.Conclusion Hepatectomy is a safe and feasible treatment for young and elderly patients with primary hepatic carcinoma.The independent prognostic factors of survival for young patients are pre-operative albumin level <3 5 g/L and the maximum tumor diameter ≥5 cm.
ABSTRACT
Objective To study the diagnosis and treatment of cytomegalovirus (CMV) infection after liver transplantation. Methods The clinical data of 111 patients who received liver transplantation from November 2000 to December 2007 in our hospital were analyzed retrospectively. The recipients were diagnosed as having CMV infection by the predisposing factors, clinical symptoms and detection of CMV-PP65 and CMV-IgM in peripheral blood specimens in combination with chest X-ray. The treatment of CMV infection was administration of Ganciclovir. Results Five recipients were diagnosed as having CMV infection, with the incidence of 4.5%. Two were diagnosed as having CMV pneumonitis, with the incidence of 1.8% (40% of the recipients having CMV infection). Two were both improved. Three were diagnosed as having CMV active infection. Two of them were cured and one was improved. Conclusion The detection of CMV-PP65 is necessary for early diagnosis and guiding treatment of CMV infection. Ganciclovir can exert significant therapeutic effects on CMV infection.
ABSTRACT
Objective To investigate the risk factors associated with early mortality (within 30 days) of patients with spontaneously ruptured hepatocellular carcinoma (SRHCC) and assess the efficacies of different treatment regimens. Methods The clinical data of 28 patients with SRHCC who had been admitted to our hospital from January 1999 to January 2006 were retrospectively analyzed. Multiple factors that might cause early mortality were determined, and the efficacies of different treatment regimens were assessed. Results Eleven patients died within 30 days. with the mortality rate of 39%. Univariate analysis showed that shock, Child C status, hemoglobin. ALT, and volume of blood transfusion were associated with early mortality (X2=3.020, 13.741, Z=-2.059, -2.210, -4.153, P<0.05). Child C status and volume of blood transfusion were the independent risk factors. All the patients were divided into hepatectomy group (8 cases), surgical hemostasis group (7 cases), transarterial embolization group (7 cases) and conservative group (6 cases). Patients in hepatectomy group had a better 30-day and median time survival rate compared with those in the other 3 groups (X2=8.098, 8.098, 15.025, Z=-3.127, -2.840, -3.004, P<0.05). Conclusions Poor hepatic functional reserve and severe hemorrhage are closely associated with early mortality of patients with SRHCC. Hepatectomy is a better choice for SRHCC.